This Award will allow the applicant to continue his present level of teaching in the field of geriatric psychiatry and allow him to expand his clinical research effort. It will so do by decreasing the amount of time he spends directing a clinical inpatient unit by three months per year during the three years covered by the Award. This Award will allow the applicant to expand his research interest into the area of treatment resistant depression occurring in the elderly. The proposed project will be divided into two major sections. The first section will focus on epidemiologic issues in refractory or treatment resistant depression in older people. A cohort of elderly admissions at the Phipps Clinic will be identified over a nine month period. They will then be followed over the next nine months. Patients meeting specific criteria for treatment failure will be identified and compared to patients who have responded to treatment. Based on these findings, a protocol will be drawn up in which interventions to decrease the incidence of treatment resistance will be devised. A treatment group and control group of patients treated by their ward physician will be identified over nine months period. A follow up will take place over the last nine months of the study to determine if the intervention has been successful.